Healthcare Provider Details

I. General information

NPI: 1154233211
Provider Name (Legal Business Name): INTEGRATED MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 INDUSTRIAL DR
HAMBURG PA
19526-8768
US

IV. Provider business mailing address

82 TUNNEL RD
POTTSVILLE PA
17901-3869
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-5616
  • Fax: 570-622-5618
Mailing address:
  • Phone: 570-622-5455
  • Fax: 570-622-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 570-622-5455